天津医药 ›› 2025, Vol. 53 ›› Issue (9): 932-936.doi: 10.11958/20251184

• 临床研究 • 上一篇    下一篇

系统性免疫炎症指数与IgA肾病患者临床病理特征的关系

李硕(), 张云鹏, 黄艳, 曹美然, 贾兰芳, 胡桂才, 黄兰(), 段书众   

  1. 承德医学院附属医院肾脏内科(邮编067000)
  • 收稿日期:2025-03-24 修回日期:2025-05-14 出版日期:2025-09-15 发布日期:2025-09-16
  • 通讯作者: E-mail:lan.hh@163.com
  • 作者简介:李硕(1992),女,主治医师,主要从事IgA肾病等慢性肾脏疾病方面研究。E-mail:1397461449@qq.com
  • 基金资助:
    河北省医学科学研究课题(20242090)

The relationship between the systemic immune-inflammation index and the clinical pathological characteristics of patients with IgA nephropathy

LI Shuo(), ZHANG Yunpeng, HUANG Yan, CAO Meiran, JIA Lanfang, HU Guicai, HUANG Lan(), DUAN Shuzhong   

  1. Department of Nephrology, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
  • Received:2025-03-24 Revised:2025-05-14 Published:2025-09-15 Online:2025-09-16
  • Contact: E-mail: lan.hh@163.com

摘要:

目的 探讨系统性免疫炎症指数(SII)与IgA肾病(IgAN)患者临床病理特征的相关性。方法 选取行肾穿刺病理活检并首次被诊断为原发性IgAN的患者350例,收集患者的临床和病理资料,计算SII。以患者外周血SII水平的中位数554.78为界,将IgAN患者分为低SII组(SII≤554.78,175例)和高SII组(SII>554.78,175例)。根据是否存在毛细血管内增生性(E)病变将患者分为E0组279例(79.7%)和E1组71例(20.3%)。多因素Logistic回归分析确定IgAN患者E病变的影响因素。建立预测模型,采用受试者工作特征(ROC)曲线评价模型的预测价值。结果 高SII组的收缩压(SBP)、血小板计数(PLT)、中性粒细胞计数(NEU)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、总胆固醇(TC)、血肌酐(Scr)、血清C3、24 h尿蛋白水平均高于低SII组,淋巴细胞计数(LYM)水平低于低SII组(P<0.05)。病理学表现,高SII组E1占比高于低SII组(P<0.05)。E0组患者PLT、NEU、NLR、PLR、Scr、24 h尿蛋白及SII水平低于E1组,血红蛋白(Hb)、LYM、白蛋白(ALB)水平高于E1组(P<0.05)。多因素Logistic回归分析显示,SII、Scr、24 h尿蛋白水平升高是IgAN患者发生E1病变的独立危险因素(P<0.05)。据此建立的IgAN患者发生E1病变的预测模型的曲线下面积(AUC)为0.781(95%CI:0.722~0.840)。结论 SII可以反映IgAN患者临床和病理的严重程度,为临床评估IgAN患者病变情况提供新思路。

关键词: 肾小球肾炎, IgA, 蛋白尿, 系统性免疫炎症指数, 毛细血管内增生

Abstract:

Objective To explore the correlation between the systemic immune-inflammation index (SII) and the clinical and pathological characteristics of patients with IgA nephropathy (IgAN). Methods A total of 350 patients who underwent renal biopsy and were initially diagnosed with primary IgAN were selected. The clinical and pathological data of the patients were collected, and SII was calculated. According to the median SII level of 554.78 in peripheral blood, the IgAN patients were divided into the low SII group (SII ≤ 554.78, 175 cases) and the high SII group (SII > 554.78, 175 cases). Based on the presence or absence of endocapillary hyperplastic (E) lesion, 350 patients were also divided into the E0 group (279 cases, 79.7%) and the E1 group (71 cases, 20.3%). Multivariate Logistic regression analysis was conducted to determine the influencing factors of E1 in IgAN patients. A predictive model was established, and the predictive value of the model was evaluated using the receiver operating characteristic (ROC) curve. Results There were higher systolic blood pressure (SBP), platelet count (PLT), neutrophil count (NEU), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), total cholesterol (TC), serum creatinine (Scr), serum C3 and 24-hour urine protein levels in the high SII group than those of the low SII group, while the lymphocyte count (LYM) was lower (P<0.05). In terms of pathological manifestations, the proportion of E1 was higher in the high SII group than that of the low SII group (P<0.05). There were lower PLT, NEU, NLR, PLR, Scr and 24-hour urine protein in patients of the E0 group than those of the E1 group, while higher Hb, LYM and ALB levels in the E0 group than those of the E1 group (P<0.05). Multivariate Logistic regression analysis showed that elevated SII, Scr and 24-hour urine protein levels were independent risk factors for E1 lesion in IgAN patients (P<0.05). The area under the curve (AUC) of the predictive model for E1 lesion in IgAN patients was 0.781(95%CI:0.722-0.840). Conclusion SII can reflect the clinical and pathological severity in IgAN patients, providing new insights for clinical evaluation of the disease progression in IgAN patients.

Key words: glomerulonephritis, IgA, proteinuria, systemic immune inflammation index, endocapillary hypercellularity

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